Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation
Authors: Christian E. Anderson, Randy A. Lieberman, Brian Olshansky
Journal: Annals of Internal Medicine (2023)

LettersMarch 2023Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial FibrillationChristian E. Anderson, MD, PhD, Randy A. Lieberman, MD, Brian Olshansky, MDChristian E. Anderson, MD, PhDUniversity of Iowa Carver College of Medicine, Iowa City, IowaSearch for more papers by this author, Randy A. Lieberman, MDWayne State University School of Medicine, Detroit, MichiganSearch for more papers by this author, Brian Olshansky, MDUniversity of Iowa Hospitals, Iowa City, IowaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L22-0516 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: We congratulate Chew and colleagues (1) on their careful analysis. This study uses presently available data to identify optimal stroke prevention strategies in patients with atrial fibrillation (AF) on the basis of individual risk profiles. The authors concluded that stroke risk must be sufficiently low (preferably with elevated bleeding risk) for left atrial appendage occlusion (LAAO) to be preferred over oral anticoagulants (OACs) (1). In no instance was LAAO superior. As such, we question who should have LAAO.This question and whether selected patients at particularly high or low risk have the option of no antithrombotic therapy ...References1. Chew DS, Zhou K, Pokorney SD, et al. Left atrial appendage occlusion versus oral anticoagulation in atrial fibrillation. A decision analysis. Ann Intern Med. 2022;175:1230-39. [PMID: 35969865] doi:10.7326/M21-4653 LinkGoogle Scholar2. Whitlock RP, Belley-Cote EP, Paparella D, et al; LAAOS III Investigators. Left atrial appendage occlusion during cardiac surgery to prevent stroke. N Engl J Med. 2021;384:2081-91. [PMID: 33999547] doi:10.1056/NEJMoa2101897 CrossrefMedlineGoogle Scholar3. Eikelboom JW, Connolly SJ, Bosch J, et al; COMPASS Investigators. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017;377:1319-30. [PMID: 28844192] doi:10.1056/NEJMoa1709118 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Christian E. Anderson, MD, PhD; Randy A. Lieberman, MD; Brian Olshansky, MDAffiliations: University of Iowa Carver College of Medicine, Iowa City, IowaWayne State University School of Medicine, Detroit, MichiganUniversity of Iowa Hospitals, Iowa City, IowaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L22-0516. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLeft Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation Derek S. Chew , Ke Zhou , Sean D. Pokorney , David B. Matchar , Sreekanth Vemulapalli , Larry A. Allen , Kevin P. Jackson , Zainab Samad , Manesh R. Patel , James V. Freeman , and Jonathan P. Piccini Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation Derek S. Chew , Jonathan P. Piccini Metrics March 2023Volume 176, Issue 3KeywordsAnticoagulantsAtrial fibrillationHemorrhageHemorrhagic strokeIschemic strokeQuality of lifeStroke ePublished: 21 March 2023 Issue Published: March 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...